Attention-deficit/hyperactivity disorder (ADHD) in cultural context II: a comparison of the links between ADHD symptoms and waiting-related responses in Hong Kong and UK.

The concept of attention-deficit/hyperactivity disorder (ADHD) is considered to have cross-cultural validity, but direct comparisons of its psychological characteristics across cultures are limited. This study investigates whether preschool children's ADHD symptoms expressed in two cultures with different views about child behaviour and parenting, Hong Kong and the UK, show the same pattern of associations with their waiting-related abilities and reactions, an important marker of early self-regulation. A community sample of 112 preschoolers (mean age = 46.22 months; 55 from UK, 57 from HK) completed three tasks measuring different waiting elements - waiting for rewards, choosing the amount of time to wait, and having to wait unexpectedly when a task is interrupted. Participants' waiting-related behavioural and emotional reactions were coded. Parents rated their children's ADHD symptoms and delay aversion. Our findings revealed that the associations between ADHD symptoms and waiting-related responses were comparable in both UK and HK samples. This suggests that the core psychological characteristics of ADHD, particularly in relation to waiting behaviours, may exhibit similarity across cultural contexts. Future research can extend this cross-cultural analysis to other ADHD-related psychological domains and explore additional cultural settings.

Brief Report: A Randomized Controlled Trial of a Digital Working Memory Intervention for Preschoolers Displaying ADHD Symptoms.

PURPOSE: This study aimed to investigate the effects of a self-paced digital working memory (WM) intervention on preschoolers with ADHD symptoms and explore the relation between WM and time perception (TP) through a randomized controlled trial. METHOD: Fifty preschoolers between four-to-six years of age (M = 4.93 years) were randomly assigned to three groups: a WM training group (WM; n = 14), a social-emotional (SE) training active control group (n = 15), and a waitlist control group (n = 21). Both the WM and SE groups received fifteen 10-min self-paced digital training sessions over five consecutive weeks. RESULTS: The digital WM training was effective in improving children's digit span performance compared to the waitlist control group only. Within-group comparisons across two time points indicated a near-significant improvement in numeration and trends of reduced ADHD symptoms and improved TP tasks in the WM group at the post-test, but between-group differences were not observed. CONCLUSION: The study showed limited effects of the WM training on preschoolers displaying ADHD symptoms. However, the results implied an association between working memory and time perception that awaits further investigation.

Word reading transfer in two distinct languages in reading interventions: How Chinese-English bilingual children with reading difficulties learn to read.

PURPOSE: Skills developed from literacy training in L1 are shown to transfer to reading in L2 when both languages involve an alphabetic writing system. However, transfer of literacy skills between a logographic L1 and an alphabetic L2 is less studied. This study examined whether the gain in literacy skills after an 8-week training on 1) Chinese character recognition or 2) English phonics, may generalize across the two languages in Chinese elementary students with reading disabilities. METHODS: Chinese-speaking students identified with reading difficulties were randomly assigned to the Chinese intervention (Chinese character orthography training), English intervention (English phonics training), and control groups. Their Chinese and English literacy skills were measured before and after the interventions. RESULTS: Though training on the orthography of Chinese characters significantly improved performance in Chinese word reading and Chinese orthographic awareness, our results did not provide evidence for the generalization of word-decoding skills from L1 Chinese to word reading in L2 English. However, phonics training in L2 English benefitted not only English word reading, but also cross-language word reading in L1 Chinese. CONCLUSION: We postulated that teaching children analytical skills in decoding words in an alphabetic writing system might likewise benefit their word decoding in a logographic script.

Sensitivity Training for Mothers With Premature Infants: A Randomized Controlled Trial.

OBJECTIVE: This single-blind parallel design randomized controlled trial evaluated the feasibility and effectiveness of a modified version of the Mother-Infant Transaction Program (MITP) in enhancing Chinese mothers' sensitivity towards their premature infants' physiological and social cues. METHODS: Sixty mothers of hospitalized premature infants (mean gestational age = 32.1 weeks; SD = 2.8) were randomly assigned to either the MITP group or the treatment-as-usual control group. The intervention group (n = 30) received four sessions of parental sensitivity training adapted from the MITP, delivered by clinical psychologists before the infants were discharged. The control group (n = 30) received standard care provided by the hospitals. Each dyad was assessed at baseline (Time 1), immediately after intervention (Time 2), and when the infants were at the gestation-corrected ages of 3, 6, 9, and 12 months (Times 3-6). Maternal sensitivity, mother-infant interaction quality, parenting stress, postpartum depression, and mother's perception of infant's temperament were measured at Times 1-4, whereas infants' weight gain and developmental performance were assessed at Times 3-6. RESULTS: The MITP group showed significantly higher maternal sensitivity and better mother-infant interaction quality after completing the training. They also reported less parenting stress and postnatal depression than the control group at Time 2 and subsequent follow-ups. The intervention significantly predicted better weight gain and developmental outcomes in infants across Times 3-6, mediated by maternal wellbeing and interaction quality. CONCLUSION: Our results demonstrated the feasibility and effectiveness of this adapted sensitivity training among Chinese mothers with premature infants. [ClinicalTrials.gov NCT04383340].

Do Executive Dysfunction, Delay Aversion, and Time Perception Deficit Predict ADHD Symptoms and Early Academic Performance in Preschoolers.

Children with attention deficit/hyperactivity disorder (ADHD) are commonly observed to have learning difficulties. This study examined how three neuropsychological constructs-executive dysfunction, delay aversion, and time perception-were associated with ADHD symptoms and early academic performance in preschoolers at risk of ADHD. One hundred and thirty-one preschoolers (70 boys, 53%) aged 4 to 6 (M = 5.31 years) were assessed on their ADHD-related behaviors, neuropsychological functioning, word reading, and math abilities at two time points one year apart. Factor analysis indicated that inhibitory and attentional control deficit, delay aversion, and time perception/working memory deficit were three dissociable factors. Among the three factors, inhibitory and attentional control measured at Time 1 was the strongest predictor of ADHD symptoms at both Time 1 and Time 2. Time perception was closely related to working memory, and they predicted word reading and numeration across time most strongly among other neuropsychological constructs. Our findings suggested that inhibitory and attentional control, delay aversion, and time perception are dissociable neuropsychological deficits underlying ADHD symptoms in preschoolers. Poor time perception may serve as a marker for the early identification of preschoolers with potential learning problems, and a possible target of intervention for ADHD.

Attention-deficit/hyperactivity disorder (ADHD) in cultural context: Do parents in Hong Kong and the United Kingdom adopt different thresholds when rating symptoms, and if so why?

OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) prevalence is similar across world regions. However, because informants' decision thresholds may vary between regions, these similarities may mask regional variations in actual ADHD behaviours. We tested this by comparing the relationship between informant's ratings and children's measured activity in United Kingdom (UK) and Hong Kong (HK) and then explored whether any national differences in endorsement thresholds discovered are linked to cultural variations in parenting factors. METHODS: Parents rated the 18 ADHD symptoms in 112 three-to-five-year-old children stratified for ADHD symptom levels (49 girls and 63 boys; 55 from the UK and 57 from HK) and completed some parenting questionnaires. Children's task-related activity was measured using actometers. RESULTS: In both groups, measured activity was positively correlated with hyperactivity/impulsivity (r = 0.44HK ; r = 0.41UK ). While HK children were less active than UK children (p < 0.01), HK parents rated their children as more hyperactive/impulsive and inattentive (ps < 0.05). The lower rating threshold indicated by this pattern in HK parents were explained by their higher child-related stress levels. CONCLUSIONS: UK and HK parents operated different ADHD symptom endorsement thresholds. The link between these and child-related stress may mark a more general role of cultural pressure for child conformity and school achievement in HK.

Validation of a developmental screening checklist for Chinese preschoolers in Hong Kong.

There are concerns about the cultural validity of applying developmental screeners developed and normed in Western countries to other sociocultural contexts. Given the scarcity of culturally validated developmental checklists for use among Chinese children, the Hong Kong Society for the Protection of Children (HKSPC) has developed the HKSPC Developmental Checklist (HKSPC-DC) for preschool teachers to identify children at risk of developmental delays through daily observation of children's functioning at school. This study explored the psychometric properties of the HKSPC-DC among 1183 preschool children aged 2-6 recruited from 14 nursery schools in Hong Kong. The HKSPC-DC showed excellent internal consistency, good interrater and test-retest reliabilities, and acceptable concurrent validity when correlated with the Taipei City Developmental Checklist for Preschoolers (Taipei II), which is the only screening instrument developed in a Chinese society and validated across 4- to 72-month-olds. The HKSPC-DC also showed good discriminatory power in identifying preschoolers potentially at risk of developmental delays. This screening tool may help facilitate early identification of children with developmental vulnerabilities in Chinese preschool populations.

Early cognitive intervention using mediated learning for preschoolers with developmental delay: A randomized controlled trial.

BACKGROUND: The use of mediated learning in cognitive training has been shown to be effective in enhancing students' cognitive development. Nonetheless, its effects on language development are less explored. AIMS: This study examined the effects of an early cognitive intervention (Think Bright program) in enhancing the cognitive and language development of Hong Kong preschoolers with developmental delay. METHOD: Sixty-eight children (48 boys and 20 girls; mean age = 58 months) with developmental delay were recruited from preschool rehabilitation centres and randomized to two groups (Think Bright training vs. active control). Each child in the Think Bright group received 12 sessions of 1-hr individual training on thinking skills over 6 months. The control group received the same amount of training based on the regular training regimen adopted at the rehabilitation centres. RESULTS: After a 6-month intervention, the Think Bright group significantly outperformed the control group in language, general cognition, analogical thinking, sequential thinking, and logical reasoning. The Think Bright teachers' mediation skills significantly improved during the course of intervention and correlated moderately with the improvement in students' language abilities. CONCLUSION: This study has shown promising results on the effectiveness of using mediated learning in early cognitive intervention in enhancing both the cognitive and language development of preschoolers with developmental delay.

Time Perception Deficits in Children and Adolescents with ADHD: A Meta-analysis.

OBJECTIVE: Prior studies have reported time perception impairment in children and adolescents with ADHD but the results were inconsistent. METHOD: The current meta-analysis reviews 27 empirical studies published in English after year 2000 that compared time perception competence among children and adolescents with and without ADHD. RESULTS: Results from 1620 participants with ADHD and 1249 healthy controls showed significant timing deficits in ADHD. Children/adolescents with ADHD perceived time less accurately (Hedges' g > 0.40), less precisely (Hedges' g = 0.66) and had higher tendency to overestimate time than their healthy counterparts. Moderator analyses indicated that the discrepancy of time perception between groups was not affected by the type of timing tasks nor the modality of stimuli used in the tasks. Nonetheless, results were moderated by age and gender. CONCLUSION: These findings may update current understanding of the underlying neuropsychological deficits in ADHD and provide insight for future research in clinical assessments and treatments for ADHD.

Emotion Coaching Intervention for Chinese Mothers of Preschoolers: A Randomized Controlled Trial.

Preschoolers' emotional development typically hinges on the family emotional climate and their interactions with caregivers. This study used a randomized controlled trial to examine the treatment efficacy of an emotion coaching parenting intervention culturally adapted from the Tuning in to Kids® (TIK) program in enhancing Chinese mothers' emotional responsiveness in parenting. A total of eighty-nine mothers with preschoolers were randomly assigned to either the intervention or waitlist control group. The TIK group received six weekly sessions of intervention on emotion coaching parenting training. The training significantly improved participating mothers' positive involvement and the use of emotion coaching in their parenting practices. More expressive encouragement and emotion-focused reactions to children's emotion expression, and less punitive parenting and emotional dismissing were also found in the mothers after training. Our findings provided the first evidence in a non-Western sample to support the effectiveness of such program in enhancing parents' efficacy in facilitating their children's emotional development.

Autism spectrum disorder screening in Chinese-language preschools.

LAY ABSTRACT: The 13-item Classroom Observation Scale is an autism spectrum disorder screening tool for teachers and non-clinically trained observers to make real-time observation of children's peer interaction (or the lack thereof) in regular preschool classrooms. The Classroom Observation Scale was originally developed in English and validated with ethnically diverse preschoolers at English-speaking international schools serving families from middle to middle-upper socioeconomic backgrounds in Hong Kong. These private schools can usually afford a higher teacher-student ratio, which is not typical for most preschools. This study, therefore, investigated whether the Classroom Observation Scale is ecologically valid when used by Chinese teachers with teacher-student ratios typically found in less-resourced preschools. We found that the Classroom Observation Scale reliably helped observers with little or no clinical training-research assistants with just a few hours of Classroom Observation Scale training and preschool teachers with an hour of briefing-to identify children in their first year of Chinese-language preschool who were more likely than their peers to have autism spectrum disorder. Reliability estimates of Classroom Observation Scale-Teacher and Classroom Observation Scale-Researcher in this study were comparable to those for the original English Classroom Observation Scale. Our results provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and non-clinically trained observers in the early identification of children with autism spectrum disorder in community settings.

Tuning in to kids: A randomized controlled trial of an emotion coaching parenting program for Chinese parents in Hong Kong.

Tuning in to Kids (TIK) is a parenting program that focuses on emotion coaching and is evidenced to be effective in Western populations. This study used a randomized controlled trial to examine the intervention effects of TIK on Chinese parents of low to middle socioeconomic status in Hong Kong. One hundred four parents (99 mothers and five fathers; Mage in years = 37.92) of preschoolers aged 3-6 years were randomly assigned to the experimental (n = 54) or waitlist control group (n = 50). Parent and child outcomes were assessed at baseline (Time 1), immediately after the 6-week intervention (Time 2), and 6 weeks postintervention (Time 3), using the Alabama Parenting Questionnaire, Coping with Children's Negative Emotions Scale, Parenting Stress Index-Short Form, and Emotion Regulation Checklist. The experimental group reported significant reductions in punitive parenting and parenting stress at Time 2, and these effects were maintained at Time 3. Delayed improvements in parents' use of expressive encouragement and children's emotion lability/negativity were observed at Time 3 in the experimental group. The immediate intervention effects were replicated in the waitlist control group at Time 3 after they attended the training. This study represented one of the few randomized controlled trials of TIK conducted in a non-Western sample. Our results corroborated the findings of prior studies of TIK and provided preliminary support for its effectiveness across different cultural contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effectiveness and Mechanisms of Mindfulness Training for School Teachers in Difficult Times: A Randomized Controlled Trial.

OBJECTIVES: Research in recent years has shown that mindfulness-based interventions can enhance teachers' mental and physical health. However, the existing studies were predominantly conducted in Western, educated, industrialized, rich, and democratic (WEIRD) societies. As a randomized controlled trial in a non-WEIRD society, the present study examined the effectiveness and mechanisms of mindfulness training for Hong Kong teachers in difficult times. METHODS: Teachers from primary and secondary schools (n = 186) were randomly assigned to mindfulness training (eight-week .b Foundations) or waitlist control condition. They completed online self-report surveys on measures of well-being, emotion management, and mindfulness in teaching at baseline, post-intervention, and two-month follow-up. RESULTS: The intervention group reported significantly higher levels of life satisfaction, positive affect, general health, along with significantly lower levels of insomnia, stress, and negative affect than the control group at post-test and two-month follow-up. The effect sizes were medium to large (η p 2 = 0.06 to 0.14). More importantly, teachers' baseline well-being had a significant moderating effect on the intervention effectiveness. Those with a lower baseline in well-being benefitted more than their counterparts with a higher baseline. In addition, teachers' emotion management was found to be the mediator through which mindfulness training enhanced teachers' well-being. Such improvement in well-being also predicted higher levels of mindfulness in teaching. CONCLUSIONS: This study provides evidence on the efficacy of mindfulness training for teachers beyond WEIRD societies. It suggests the universality and practicality of mindfulness training in enhancing teachers' well-being and reducing their distress in difficult times.

Dimensional structure of the BRIEF2 and its relations with ADHD symptoms and task performance on executive functions in Chinese children.

This study examined the dimensional structure of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) in a Chinese sample of children with attention-deficit/hyperactivity disorder (ADHD)-related concerns and the correlations of the BRIEF2 with the children's ADHD symptoms and their performance on executive function (EF) tasks. Participants were 339 Chinese children aged 6-15 (M = 9.18 years, SD = 2.33; boys: 78.2%) recruited from 35 schools in Hong Kong. The results from confirmatory factor analyses revealed the best fit for a three-factor nine-scale model compared to a two-factor or single-factor model. Significant correlations were found between the BRIEF2 parent and teacher forms for the Behavioral Regulation Index and Cognitive Regulation Index, but not for the Emotion Regulation Index. Associations between performance on an EF task and the rating of the corresponding subscale on the BRIEF2 purportedly measuring the same EF construct were not consistently observed. Lastly, the BRIEF2 showed good convergent validity with the ratings of ADHD symptoms on the Swanson, Nolan, and Pelham Rating Scale Version IV (SNAP-IV). This study provided plausibly the first evidence on the dimensional structure of the BRIEF2 Parent and Teacher Forms in an Asian sample and confirmed the factorial validity of the Chinese version of the BRIEF2.

Acceptance of outgroup members in schools: Developmental trends and roles of perceived norm of prejudice and teacher support.

BACKGROUND: Schools around the world are increasingly diverse in ethnicity. Given the importance of peer acceptance in children's well-being and development, it is a pressing concern for educators to promote intergroup acceptance in schools. AIMS: First, to examine the developmental trends of acceptance of outgroup members in both the ethnic minority and majority students. Second, to investigate how outgroup acceptance is subject to the interplay between perceived norm of prejudice, a risk factor in the macrosystem, and teacher support, a protective factor in the microsystem. SAMPLE: The participants were 3,723 students (ethnic majority: 61%; boys: 51.9%; mean age: 13.7) at Grade 2, 5, 8, and 11 from 24 schools in Hong Kong. METHODS: The students were asked to complete a battery of questionnaires regarding their willingness to accept outgroup members in schools, perceived societal norm of prejudice against ethnic minority group, and teacher support they received in schools. RESULTS: It was found that ethnic minority students accepted outgroup members more than ethnic majority students accepted them. The difference was primarily driven by the low outgroup acceptance of ethnic majority students in Grades 2 and 5. The results of multi-level analysis revealed that outgroup acceptance was associated negatively with perceived norm of prejudice but positively with teacher support. The negative association between outgroup acceptance and perceived norm of prejudice was attenuated in schools with supportive culture. CONCLUSIONS: The results point to the need of early intervention and the importance of cultivating school culture with strong social emotional support.

Autism spectrum disorder screening in preschools.

LAY ABSTRACT: With professional training and regular opportunities to observe children interacting with their peers, preschool teachers are in a good position to notice children's autism spectrum disorder symptomatology. Yet even when a preschool teacher suspects that a child may have autism spectrum disorder, fear of false alarm may hold the teacher back from alerting the parents, let alone suggesting them to consider clinical assessment for the child. A valid and convenient screening tool can help preschool teachers make more informed and hence more confident judgment. We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic "stress test" to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule-2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later. This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder.

Brief Report: A Randomized Controlled Trial of the Effects of RECALL (Reading to Engage Children with Autism in Language and Learning) for Preschoolers with Autism Spectrum Disorder.

This study investigated the effects of a parent-implemented dialogic reading approach-Reading to Engage Children with Autism in Language and Learning (RECALL)-on the engagement in reading and inference-making ability for preschoolers with autism spectrum disorder (ASD). Thirty-one preschoolers (mean age = 5.90 years, SD = 0.69; 26 boys, 5 girls) were randomly assigned to a treatment or control group. Six weeks of RECALL significantly enhanced story comprehension, emotion knowledge, and reading engagement among preschoolers in the treatment group. This might be the first randomized controlled trial testing the effects of RECALL on children with ASD. Our findings suggest that additional instructional support such as the application of a prompting hierarchy during dialogic reading might help children with ASD reap greater benefits from shared book reading.

The Moderating Effect of Mindfulness on the Mediated Relation Between Critical Thinking and Psychological Distress via Cognitive Distortions Among Adolescents.

Critical thinking has been widely regarded as an indispensable cognitive skill in the 21st century. However, its associations with the affective aspects of psychological functioning are not well understood. This study explored the interrelations between trait mindfulness, critical thinking, cognitive distortions, and psychological distress using a moderated mediation model. The sample comprised 287 senior secondary school students (57% male and 43% female) aged 14-19 from a local secondary school in Hong Kong. The results revealed that high critical thinking was significantly associated with high levels of psychological distress when mindful awareness was low among adolescents. Trait mindfulness was found to moderate the indirect effects of critical thinking on psychological distress via cognitive distortions as the mediator. Specifically, in low trait mindfulness conditions, critical thinking was found to associate positively with cognitive distortions and psychological distress. Such associations were not observed in high trait mindfulness conditions. The findings reveal that though critical thinking has positive associations with cognitive functioning, its associations with affective well-being might be negative. The results also suggest that mindfulness might play an important role in preventing the possible psychological distress associated with critical thinking. Educational implications relating to the fostering of critical thinking and mindful awareness are discussed.

Learning How to Make Friends for Chinese Adolescents with Autism Spectrum Disorder: A Randomized Controlled Trial of the Hong Kong Chinese Version of the PEERS® Intervention.

This study examined the treatment efficacy of PEERS® (Program for the Education and Enrichment of Relational Skills) among Chinese adolescents with autism spectrum disorder (ASD) in Hong Kong. The original PEERS® manual was translated into Chinese, and cultural adjustments were made according to a survey among 209 local adolescents in the general population. 72 high-functioning adolescents with ASD were randomly assigned to a treatment or waitlist control group. The 14-week parent-assisted training significantly improved social skills knowledge and social functioning, and also reduced autistic mannerisms. Treatment outcomes were maintained for 3 months after training and replicated in the control group after delayed treatment. The present study represents one of the few randomized controlled trials on PEERS® conducted outside North America.